氨甲环酸不同给药方式对全髋关节置换术患者凝血功能和出血量的影响

摘要

目的 探讨氨甲环酸不同给药方式对全髋关节置换术(THA)患者凝血功能和出血量的影响.方法 将105例THA患者按给药方式分为观察组(n=53)与对照组(n=52):对照组于手术切皮前15 min内静脉滴注氨甲环酸20 mg/kg+100 ml生理盐水;观察组于术中将氨甲环酸按20 mg/kg注入关节腔,比较两组患者凝血功能和出血量的差异.结果 术后活化部分凝血酶原时间、纤维蛋白原、凝血酶原时间观察组均低于对照组,但差异无统计学意义(P>0.05).引流量、总失血量与隐性失血量观察组均明显少于对照组,差异有统计学意义(P<0.001).两组患者术后Hb水平均低于术前,差异有统计学意义(P<0.05).观察组术后Hb水平明显高于对照组,术后Hb减少量与输血量明显少于对照组,差异均有统计学意义(P<0.01).观察组输血率为7.55%,明显低于对照组的21.15%,差异有统计学意义(P<0.05).两组患者均无肺栓塞.下肢深静脉血栓形成发生率观察组为3.77%,对照组为7.69%,差异无统计学意义(P>0.05).结论 THA术中氨甲环酸关节腔给药可减少出血量,降低输血率,且不影响凝血功能,不增加下肢深静脉血栓形成的发生风险.%Objective To study the influence of the blood coagulation function and bleeding of different application methods of tranexamic acid for patients with total hip arthroplasty(THA).Methods Total 105 cases patients with THA were divided into observation group (n=53) and the control group (n=52): control group was given tranexamic acid 20 mg/kg+100 ml saline intravenous drip within 15 min before cutting skin.Observation group was given 20 mg/kg tranexamic acid by articular cavity injection during THA,and the difference of blood coagulation function and the bleeding were compared between the two groups.Results Activated partial prothrombin time(APTT) and fibrinogen (FIB),prothrombin time(PT)of observation group were lower than the control group,APTT,FIB,PT were compared between two groups,with no statistically significant difference (P>0.05).The volume of drainage,total blood loss and hidden blood loss of observation group were significantly less than control group,compared with statistically significant differences (P<0.001).Postoperative Hb levels of two groups patients were significantly lower than preoperation,there was significant difference (P<0.05),Hb levels of observation group were obviously higher than control group,postoperative Hb reducing volume and blood transfusion volume were obviously less than control group,there was significant difference (P<0.001).Blood transfusion rate of 7.55% in observation group was obviously lower than control group of 21.15%,compared with significant difference (P<0.05).Two groups patients had no pulmonary embolism,deep vein thrombosis incidence rate of observation group was 3.77%,control group was 7.69%,they were compared between two groups,with no statistical significance(P>0.05).Conclusions Articular cavity applying tranexamic acid during THA can reduce blood loss,and obviously decrease blood transfusion rate,and can not affect blood coagulation function or increase deep vein thrombosis risk.